Healthcare ethics: The experience after the Haitian earthquake


  • Mill Etienne, MD, MPH
  • Clydette Powell, MD, MPH, FAAP
  • Dennis Amundson, DO, MS, FACP



disaster relief, Haiti, earthquake, Operation Unified Response, humanitarian assistance


On January 12, 2010, a 7.0 Richter earthquake devastated Haiti and its public health infrastructure leading to a worldwide humanitarian effort. The United States sent forces to Haiti’s assistance including the USNS Comfort, a tertiary care medical center on board a ship. Besides setting a transparent triage and medical regulating system, the leadership on the Comfort instituted a multidisciplinary Healthcare Ethics Committee to assist in delivering the highest level efficient care to the largest number of victims. Allocation of resources was based on time-honored ethics principles, the concept of mass casualty triage in the setting of resource constraints, and constructs developed by the host nation’s Ministry of Health. In offering aid in austere circumstances, healthcare practitioners must not only adhere to the basic healthcare ethics principles but also practice respect for communities, cultures, and traditions, as well as demonstrate respect for the sovereignty of the host nation. The principles outlined herein should serve as guidance for future disaster relief missions. This work is in accordance with BUMEDINST 6010.25, Establishment of Healthcare Ethics Committees.

Author Biographies

Mill Etienne, MD, MPH

Department of Neurology, National Naval Medical Center, Bethesda, Maryland; Assistant Professor of Neurology, Uniformed Services University of Health Sciences, Bethesda, Maryland; Neurologist and Chief-Healthcare Ethics Committee on board USNS Comfort (T-AH 20) for Operation Unified Response-Haiti, LCDR, USN.

Clydette Powell, MD, MPH, FAAP

Medical Officer, Bureau for Global Health, US Agency for International Development, Washington, District of Columbia; Associate Professor of Pediatrics, George Washington University, Washington, District of Columbia; Pediatric Neurologist on board USNS Comfort (T-AH-20) for Operation Unified Response-Haiti.

Dennis Amundson, DO, MS, FACP

Critical Care Physician, Naval Medical Center, San Diego, California; Associate Professor of Internal Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland; Intensivist on board USNS Comfort (T-AH 20) for Operation Unified Response-Haiti, CAPT, USN.


United States Geological Survey: Historical World Earthquakes. Available at country.php. Accessed March 20, 2010.

Ramirez M, Peek-Asa C: Epidemiology or traumatic injuries from earthquakes. Epidemiol Rev. 2005; 27: 47–55.

Hunt MR: Resources and constraints for addressing ethical issues in medical humanitarian work: Experiences of expatriate healthcare professionals. Am J Disaster Med. 2009; 4(5): 261–271.

Thomas JC, MacDonald PD,Wenink E: Ethical decision making in a crisis: A case study of ethics in public health emergencies. J Public Health Manag Pract. 2009; 15(2): E16-E21.

Barnett DJ,Taylor HA, Hodge JG Jr, et al.: Resource allocation on the frontlines of public health preparedness and response: Report of a summit on legal and ethical issues. Public Health Rep. 2009; 124(2): 295-303.

United Nations Childrens Fund: Haiti: Country statistics at a glance. Available at statistics.html. WHO/UNICEF survey data base. Accessed March 23, 2010.

Central Intelligence Agency: The World Fact Book. Available at geos/ha.html. Accessed March 23, 2010.

Bigelow J, Korth M, Jacobs J, et al.: A picture of amputees and the prosthetic situation in Haiti. Disabil Rehabil. 2004; 26(4): 246-252.




How to Cite

Etienne, MD, MPH, M., C. Powell, MD, MPH, FAAP, and D. Amundson, DO, MS, FACP. “Healthcare Ethics: The Experience After the Haitian Earthquake”. American Journal of Disaster Medicine, vol. 5, no. 3, May 2010, pp. 141-7, doi:10.5055/ajdm.2010.0018.